Provider Demographics
NPI:1265056444
Name:NOBOA GALLARDO, DANILO SEBASTIAN (MD)
Entity type:Individual
Prefix:
First Name:DANILO
Middle Name:SEBASTIAN
Last Name:NOBOA GALLARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-8611
Mailing Address - Fax:515-643-8812
Practice Address - Street 1:330 LAUREL ST STE 2100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3068
Practice Address - Country:US
Practice Address - Phone:515-643-8611
Practice Address - Fax:515-643-8812
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-09-05
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-08
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-51329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program